Acute otitis media in young children – What do parents say?

Abstract

Objectives

The Ear infections Attitudes Research study investigated parental attitudes and awareness towards acute otitis media (AOM) and evaluated the burden of AOM for affected children, their families, and parental work capabilities.

Methods

This study, conducted via online interviews in October–November 2010, included parents (N = 2867) from 12 countries, whose children aged ≤3.5 years had experienced ≥1 professionally diagnosed AOM episode in the last 6 months (AOM-experienced group; N = 1438) or had never experienced any professionally diagnosed AOM episode (non AOM-experienced group; N = 1429). The interviews consisted of questions with multiple-choice, five-point scaled or free-text answers. Answers to multiple-choice questions were presented as frequencies of particular responses and those to scaled questions as mean values or percentages of parents considering each aspect as applicable.

Results

Parents considered that the main AOM burdens for affected children were pain (mean values on five-point scales: 4.4 and 4.5), disturbed sleep (4.3 and 4.3) and irritability (4.2 and 4.0) and for their families, sleepless nights (4.2 and 3.8) and worries about the child's recovery (4.1 and 4.3) and about potential long-term implications (4.0 and 4.3) in the AOM-experienced and non AOM-experienced groups, respectively. During their child's most recent AOM episode, 95% of parents in the AOM-experienced group used antibiotics, 76% reported that their doctors prescribed antibiotics for immediate use, 13% were advised to return for antibiotic prescription if symptoms did not abate and 9% received a prescription for antibiotics to use if symptoms did not improve. Both reported prescription and usage rates for antibiotics were higher than expected. When their child had AOM, 73% of parents had to be absent from work or rearrange their working hours. Among those who took leave from work, 67% stayed at home for 2–7 days.

Conclusions

Parents perceive AOM to be a burden for their child and families, particularly the pain and disturbed sleep due to AOM, and this disease had a significant effect on parents’ ability to attend work. Given how common AOM is, this loss of workdays may lead to substantial financial burden for families and the society. Antibiotics were almost invariably used in all countries despite current guidelines.

Introduction

Most episodes of acute otitis media (AOM) in children are caused by bacteria, of which the three most frequently identified are Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis [1], [2], [3], [4], [5], [6]. AOM is one of the most frequent bacterial infections for which medical advice is sought and represents the most common reason for antibiotic prescription in children younger than five years of age [2], [7]. Guidelines on the clinical management of AOM in children have been developed and various countries recommend a “watch-and-wait” policy before starting treatment of AOM with antibiotics, but adherence to these guidelines is poor and early and frequent use of antibiotics continues [1], [3], [8], [9], [10], [11].

Currently, the knowledge of parents’ perceptions and attitudes regarding AOM is limited and additional studies are needed to better understand the situation of children with this disease and to determine priorities in targeting educational interventions. In previous studies, parents reported that AOM had an important burden on the affected child, themselves and their family and that this disease resulted in substantial use of medical services and loss of workdays [12], [13]. However, parental knowledge about AOM may be inaccurate; parents seem to underestimate the actual risk of their child experiencing an AOM episode and the majority of parents consider that antibiotics are always useful to treat this disease [14], [15]. Here, we present the results of the Ear infections Attitudes Research (EAR) survey, which is the largest study that has currently been conducted on a global level to investigate parental attitudes and awareness towards AOM in young children.